"This treatment is standard practice," your doctor says reassuringly. Or, you might be told it's the "best practice" or even "the gold standard" for people with your condition. You're sitting on the exam table, legs dangling, wearing a drafty paper or cloth gown clearly designed for someone who is a very different size than you. Even if you manage to keep your wits about you, what can you possibly say in response?

A number of years ago, a Washington politician who titled his ideas for health reform "Intelligent Health Care" told me that he did so because he figured, "Who's going to say that they're against intelligent health care? What does that mean they stand for? Stupid health care?"

Similarly, how can you argue when your doctor offers you a "best practice?" What are you implying that you want instead? A "worse practice"?

But calling a treatment the best practice doesn't mean that it is. The Mayo Clinic took a look at all 363 articles that analyzed standard treatments (best practices) in a medical journal over the course of 10 years. In 40 percent of the cases, those current practices were found to be worse than the approaches that doctors used to use - or else doing nothing at all actually got better results than the current approaches.

"Well, okay," you might be thinking. "That still means that the current approach was better 60 percent of the time, doesn't it?" No, it doesn't. The studies concluded that only 38 percent of the current treatments analyzed were in fact effective. In the remaining 22 percent of the cases, it wasn't possible to tell if the current treatment was better or worse than the previous treatment, or even better than no treatment at all.

The "best practices" analyzed included drugs, surgery, medical tests and so forth.

How can an approach to medical care become the standard when it doesn't actually work or isn't an improvement over an older approach? The Mayo Clinic reports that the practice "gains acceptance largely through vocal support from prominent advocates," even though the evidence in favor of it is often "inadequate, biased, and conflicted." In other words, at times health care operates a little too much like junior high, where the popular kids decide what's "in."

Disturbingly, even when a test or treatment is proved ineffective or even harmful, "removing the contradicted practice often proves challenging." The Mayo Clinic study goes on to say, "A high percentage of all practices [tests and treatments] may ultimately be found to have no net benefits."

What can you do? Ask questions - but it's useful to pick your battles. A recent viewing of a 1987 episode of the British mystery series "Inspector Morse" reminded me of this point. In that episode, a sprightly American tourist on a British bus tour asked a steady stream of questions about concerns that seemed trivial to other people; one of the surprises was that she wasn't one of the people murdered by the end of the show. It will be useful to avoid evoking similar sentiments from your doctors.

While any medical test or treatment theoretically can lead to problems, what indicators suggest that asking questions might be especially useful? Tests or treatments that are expensive, time-consuming or invasive; have a known risk of serious complications; or simply make you uneasy are typically more important to ask questions about.

You might consider asking, "How many people out of one hundred get better (or avoid further decline or live longer) because they had this test or treatment? How many do so when they get different tests or treatments for this condition? How many do just as well when they get no test or treatment at all?"

If your doctors have answers to these questions, kudos to them. If they don't, you can reasonably ask a simpler question next: "Without that information, how do you know it's the best approach?"

Above, I joked about evoking murderous sentiments in your doctors by asking too many (trivial) questions. But at the end of the day, what's at stake may be your life and your well-being. If you feel that a question is important to ask, then ask it.